Jan
23

UPDATE – Friday catch up, and follow up on the Aetna-CWCS story

Congratulations to Accident Fund’s Jeffrey Austin White – Jeff has been named Director of Innovation at the top-ten workers’ comp insurer.  I’m honored to consider Jeff a good friend.  He’s also one of the smartest people I know, and has two other all-too-rare abilities; he gets to the crux of knotty issues very, very quickly, and communicates really technical, complex stuff clearly and simply – so much so that we far-less-brilliant folks can actually understand it.

Kudos to Lisa Corless, AF’s Chief Administrative Officer for creating the position.  Innovation at a work comp carrier – there is hope for the industry yet!

Thanks to WorkCompWire for highlighting Liberty Mutual Research Institute’s recently released Workplace Safety Index.  The top two causes of injuries – overexertion and falls.  C’mon folks, let’s get in better shape!

Health Reform Implementation and health insurance

Great article by Steve Davis in Health Business Daily on the public health exchanges – couple key data points:

  • the average benchmark health plan premium increase this year was 0 percent.
  • this despite only a 1 percent increase in the average deductible
  • a lot more health insurers are offering plans on the Exchanges; McKinsey reports a 27% increase in available plan options and 19% bump in the number of insurers participating.

It’s about the prices, stupid!

It’s long been known that the primary reason health care costs in the US are so much higher than in other industrialized countries is that medical services prices are way higher.  The good news is there’s more price transparency now than ever.

The latest comes to us from WaPo’s Wonkblog, reporting the price of a knee replacement varies from $17k to $62k – in the same city (Dallas). Hip replacement costs in Boston show an even greater range – $18k – $74k.

What’s interesting about this report (which comes originally from the Blue Cross and Blue Shield Association) is it is based on the price PAID for the service by Blues plans.

UPDATE – after a query from sharp-eyed reader PW, I spoke with the Blues about the price v cost question. Media contact Robert Elfinger told me the dollar figures are, in fact, the Blues Claims Rate.  That is, what was PAID for the service.  The report was not clear on this as it mixed “price” and “cost” repeatedly.

For those who bitch about “narrow networks”, this is precisely why narrow network plans will become the industry standard in the near future; health insurers must identify low-cost, high-quality providers and direct their members to those providers if they are going to survive in the hyper-competitive Exchange-based health insurance marketplace.

Low cost or wide networks – pick one.

And health insurers are doing just fine, thank you.  From UBS comes a brief summary of Unitedhealth Group’s recent financials, and they look pretty darn good. Medical costs are coming in lower than projected despite a pretty nasty flu season, and membership growth has been higher than projected (in part due to narrow network products).

Aetna and the layoff at Coventry Workers’ Comp Services

Last week I wrote about Aetna’s decision to raise the company’s minimum wage to $16 an hour and the subsequent layoff of 11 workers at subsidiary CWCS’ office in Franklin, TN.

I’ve been talking (via email) with Aetna’s Communications folks in an effort to a) make sure I get the details right; b) get their side of the story; and c) find out what the future holds.  To their credit, my sense is they’ve been really trying to be helpful – however for some reason they’ve not been able to provide much information.  Of late, they’ve been radio silent. Here’s what I have so far.

First, I said there were 11 workers fired; Aetna says there were only 8.  It appears that there were indeed only 8 laid off, however sources indicate an additional 3 will be.

Second, in their internal announcement of the increase in the minimum wage, Aetna said there would be no layoffs, that these would of happened in December if we were going to do anything like that.”  I reviewed all press releases after April 2013, and didn’t see anything about CWCS layoffs.  In talking with some of the laid-off workers, they told me they had no indication a layoff was coming and couldn’t recall any communication of any kind about a layoff. I’m not sure the “communication” over a year ago about “targeted job reductions” can be counted as a notice by any reasonable standard. Via email, I asked Aetna if the CWCS layoff had been communicated, and was told:

in the fall of 2013 after we closed [on the deal to purchase] Coventry (in May), we communicated integration activities over at least three years, including targeted job reductions as business units conducted the activities. 

This is obviously just an oversight; CWCS is a tiny part of Aetna, and on balance Aetna is clearly doing the right thing for the vast majority of its lower-paid workers.  For several thousand employees, the wage increase is a very big deal and one Aetna should be lauded for.

CWCS is a slightly different matter.  Clearly Aetna is looking to unload the division; equally clearly (at least to me) unless they accept a very low price, that’s not going to happen. While things play out, CWCS management is doing the cash-cow thing; slashing costs and outsourcing whatever they can in an effort to maximize profits.  I get it; it makes sense from a business perspective.  However, one would hope that CWCS would follow mother Aetna’s kinder and gentler employee relations philosophy.

Note – I informed my Aetna contact I’d be posting about this today and asked three questions about possible future layoffs and any efforts to help laid-off workers find other jobs; as of now they’ve not responded.  Fortunately, after reading the post, two area employers got in touch with some of the laid-off workers as they have open positions.

 


Jan
21

Drugs dispensed by docs may well be dangerous

Greg Jones has done a masterful job finding out just who is manufacturing the new “novel” drugs being dispensed by docs to workers’ comp claimants.

In his piece in today’s WorkCompCentral, Jones finds there are just seven companies manufacturing the three novel drugs with unique strengths about which WCRI concluded “it is likely that financial incentives drove some physicians to choose the strength for their patients.” [link leads to abstract, full report available for purchase here]

According to the piece;

Several of the companies [manufacturing the novel drugs] have been fined or warned by the federal government for engaging in unsafe practices, while another paid $12 million to resolve allegations that it paid kickbacks to doctors to prescribe its products. [emphasis added]

We aren’t talking minor misdemeanors, the FDA’s equivalent of parking tickets.  Here’s a quick summary of just a few of these companies’ transgressions.

  • Ranbaxy pleaded guilty to seven felonies and paid fines of $500 million for shipping drugs that weren’t tested for impurities and making fraudulent statements about quality-control tests.
  • Victory Pharma paid $11.4 million to settle criminal and civil allegations re paying kickbacks to prescribing physicians
  • Bryant Ranch was warned by the FDA for failure to put in place systems to prevent contamination during drug manufacturing.  Bryant was also manufacturing at least 10 drugs that were unapproved by the FDA.

There’s much more in Jones’ article, which should be required reading for legislators and regulators dealing with workers’ comp.  

The net is this – putting price controls on doc dispensing doesn’t work; it is blatantly obvious the doc dispensing industry has figured out how to keep generating huge profits despite legislation or regulations in 18 states intended to limit profiteering.

Those profits come from employers and taxpayers, and they come at the risk of sickening or killing claimants.

Thanks to Greg Jones and WorkCompCentral for this – it is wonderful to see that investigative reporting isn’t dead. It is also inspiring to see how real reporters work.

What does this mean for you?

Just say no.  Refuse to pay for doc dispensed drugs.  If providers in your network are dispensing, kick them out.

If your state forces you to pay, use whatever legal methods exist – and every state has them – to delay and deny payment.

Oh, and subscribe to WorkCompCentral, too…

 


Jan
20

Tuesday catch-up

Here’s what happened over the MLK weekend…

Kudos to Sen. Amy Klobuchar (D Minn) for her efforts to reduce Medicare drug prices.  She introduced a bill that would allow CMS to negotiate drug prices, a seeming no-brainer.  Reasons to support the bill:

  • reduces Medicare recipients’ drug costs
  • reduces taxpayers costs
  • reduces the Federal deficit

Reasons to oppose the bill:

  • Big pharma, which donates gazillions to politicians, hates it.

Speaking of which, two states are suing Bug Pharma for damages associated with opioid abuse.  A lawsuit against Purdue, manufacturer of OxyContin, is proceeding in Kentucky – a state that has been devastated by opioid abuse.  The big drug maker missed a crucial deadline to file papers in the case, putting them in a even tenuous position.

Their neighbor to the north is suing a dozen pharma distributors and manufacturers, claiming the firms failed to implement adequate anti-diversion controls.  The suit was filed by the former Attorney General. This one is…complicated, as the current West Virginia Attorney General used to be a lobbyist for a big drug distributor that may be added to the suit. And, his wife is currently a lobbyist for one of the companies that is named in the suit.

Meanwhile, the explosive growth in heroin usage continues, driven in large part by folks who got addicted to prescription drugs and now seek their highs from heroin.  Which is even more deadly than Oxy; the CDC reports deaths were up 39% in 2013.

WCRI Annual Meeting

is coming up!  Scheduled for March 5-6 in Boston, the agenda includes details on WCRI’s new research on the costs and consequences of physician dispensing of drugs; the impact of the Affordable Care Act on workers’ comp, and a deep dive into the effect of low fee schedules on medical prices.  Among other luminaries, CWCI President Alex Swedlow will be there talking about the impact of doc dispensing on return to work.

The estimable Ramona Tanabe will review the “State of the States”, a must-see for payers focused on specific jurisdictions.

If you haven’t signed up yet, do it here now before it fills up – which is always does.

 Implementing Health Reform

First, the big news is…there isn’t any news about the Federal Exchange site crashing.  You can almost hear the sighs of relief coming from the White House and CMS.

A couple of items reform-related:

The percentage of people who had problems paying a medical bill declined from 41% in 2012 to 35% last year.

Even better, fewer people are avoiding medical care due to the cost; the percentage dropped from 43% to 36%.

Hiring!

Ascential Care is looking for case management staff in several jurisdictions. Contact info http://ascentialcare.com/connect/.

 


Jan
19

I’m not working Monday

Instead I’ll be finishing ‘The Half has Never Been Told’, the most disturbing book I’ve ever read.

Like many, or perhaps most, I’ve not taken Martin Luther King Day seriously in the past.  When I had it off, I used it as a catch-up day.  When I didn’t (the last 18 years) I almost always worked.

My decision is not so much about Dr. King as it is about values.  What he stood for, what he died for, what he worked for is in peril.  The events of the last few months coupled with the lack of economic progress over decades for many people of color have been a wake-up call.  We are better, far better than this.

A quote from Ohio Gov. John Kasich’s inauguration speech makes the point very well:

It’s all about me. And somehow we have lost the beautiful sound of our neighbor’s voices. Moving beyond ourselves and trying to share in the experience of others helps us open our minds, allows us to grow as people. It helps us become less self-righteous. Did you ever find that in yourself? I do…self-righteous. Allows you to be more righteous. Empathy is the first ingredient in compassion and makes it possible for us to care enough to begin to reach out to those who have been forgotten, disenfranchised, ignored, or who are suffering, and to reach out to them in the way they need.

A while back I received an email from a very successful businessman that quoted from Pat Buchanan’s unbelievably racist, stupid, ill-informed and hurtful column about racism.  To wit:

America has been the best country on earth for black folks. It was here that 600,000 black people, brought from Africa in slave ships, grew into a community of 40 million, were introduced to Christian salvation, and reached the greatest levels of freedom and prosperity blacks have ever known.

Buchanan goes on to blame blacks for pretty much everything negative affecting the black community.  I responded immediately to his email, then promptly forgot about it.

Then, I found ‘The Half’.

The book links slavery and economics tightly together, so much so that on occasion I’ve found myself forgetting that author Edward Baptist is writing about slavery – the ownership of one human being by another. Baptist seems to have recognized that risk, as he intersperses graphic and wholly terrifying descriptions of rape and child rape, family-splitting, flogging, murder and whipping throughout. He doesn’t do this gratuitously, but rather to make two points;

  • slavery is the most evil one human can do to another; and
  • without the mundane brutality employed by slave owners  the geographic expansion and economic development of the United States would have been much, much different.

For a very smart, very successful American businessman to say anything positive about slavery is just appalling.  That statement endorses absolutely horrific behavior, while perpetuating the false meme that the poor and underprivileged are solely responsible for their condition.

What utter bullshit.

If you don’t believe it, read ‘The Half’.

That’s not to say our various, sundry, and very expensive public policy efforts to alleviate poverty and racism have been universally successful – far from it.  But just because we continually screw up doesn’t mean we shouldn’t keep trying.

How a nation treats its poorest, most vulnerable, least able and least fortunate defines that nation.  And we have failed those people, and failed them miserably.

Today’s the day to think about what we can do to help.  Tomorrow – and the days after – are the days to do it.


Jan
16

Aetna raises minimum wage, then cuts work comp staff

Monday, Aetna announced it will be increasing the company’s minimum wage to $16/hour.  In the internal memorandum provided to managers, the company said “We will not be funding this program through job eliminations…

According to a source, during a company-wide webcast earlier this week, CEO Mark Bertolini said “We do NOT anticipate any lay offs. There is plenty of room for employment within the company.  That would of happened in December if we were going to do anything like that.  We are past that.”  

Wednesday, 11 employees in Coventry Workers’ Comp Services Franklin, TN office were fired.  Sources indicate layoffs have happened in several other CWCS locations as well.

While it may well be that the giant healthplan’s financial plan doesn’t directly link the firings to funding the higher wages, the timing and the details provided to this reporter show a rather unfortunate lack of planning and coordination.

Telling low-wage workers they’re getting a big raise, then, after they’ve gone home, told their spouses and kids, perhaps planned on a celebratory dinner with chuck roast instead of the usual hamburger, bought that winter coat they’d been unable to afford, and maybe even paid a couple bills, they get the “just kidding! you’re fired!” notice is, if not intentionally cruel, certainly unintentionally so.

And pretty dumb.  The company got lots of (well-deserved) positive press and supportive comments from around the country for the wage and benefits upgrade.  Then, they turn around and fire some of those same low-wage workers they’re saying they want to help.

What’s more troubling is why.

Sources indicate the jobs lost are in Coventry Work Comp Services unit, primarily handling administrative tasks including preparing network panel postings for the Hartford’s workers’ comp customers, scheduling claimant appointments, and Quality Assurance.  But they aren’t going away, rather Aetna is off-shoring them to the Philippines.  Several management staff remain on payroll for now, but their positions are also going to be eliminated after they train their Filipino replacements.

By most accounts Aetna CEO Mark Bertolini is a good guy.  He’s aware of and quite concerned about income inequality.  He asked his execs to read Thomas Piketty’s treatise on the subject.  Aetna is also significantly improving benefits for the company’s lower-wage workers. In a statement, Bertolini said:

“Since I became CEO, one of my goals has been to help re-establish the credibility of corporate America…I firmly believe that companies can ‘do well by doing good.’ With these investments, we are leaning into the recovering economy and working to bring everyone along instead of just a few.”

My read on this is Aetna is not a bad company and its execs are not bad people. There’s no intentional cruelty here, this isn’t a heartless oligarch playing God without any regard for the little gal.

While Bertolini is a good guy, some of his underlings are not.  This is a dumb decision made by a tiny division executed by crappy managers with no regard for how it affects folks making low wages doing important work for years.

My characterization of the managers is based on the timing and their petty. small-minded, and just plain stupid cost-cutting moves which included no Christmas bonuses, no holiday celebration of any kind (not even the traditional dinner), paying laid-off workers only 50% for their unused vacation time, and a paltry 4 weeks of severance for workers with more than 2 years at CWCS.

One wonders if those managers at least handed out “Merry Christmas, now get the hell out of here” cards.

What does this mean for you?

A pretty awful winter for folks who thought they were going to get a nice raise.

note- I reached out to Aetna several times, delayed this post in an effort to get their side of the story. After waiting all day, i informed them I had to go to press.

If I hear from Aetna I will let you know…

 

 


Jan
15

Shake those blahs!

Vince Kuraitis’ Health Wonk Review is just what you need to cure what ails ya!

A great snapshot of the best of the blogosphere is up and ready for your reading pleasure!

Don’t miss Julie Ferguson’s piece on the dangers of the nursing night shift – namely a significantly higher risk of premature death…


Jan
14

TRIA’s renewed, and this means…

Well, that’s a relief. In a welcome display of bipartisanship, Congress passed and the President signed into law a six-year renewal of TRIA.  Here’s how AIA described the key elements and changes to the program:

Under the six-year extension in the bill, starting in 2016, there will be phased-in increases to the program’s trigger (raising it from $100 million to $200 million in annual aggregate insured losses) and the insurer co-share (raising it from 15 percent to 20 percent).  In addition, the bill phases in an increase in the aggregate amount of insured terrorism losses required to be borne by the private sector from the current $27.5 billion to $37.5 billion. Any use of taxpayer dollars to fund those losses would be recouped post-event.

I interviewed AIA Associate General Counsel and work comp expert Bruce Wood via email to get his take on the news.

MCM – What does this mean for workers’ comp?

Bruce – The extension of TRIA eliminates the uncertainty hovering over workers’ compensation insurers in providing coverage where the ultimate risk of loss is unascertainable because of the inability to exclude terrorism losses from workers’ compensation.

MCM – Some have criticized TRIA as unnecessary; can you speak to that?

Bruce – Some critics of TRIA have said not to worry, that employers would simply be written through residual markets.  But, it is insurers who backstop the losses in residual markets. In a state with a state fund serving also as the market of last resort, the backstop is either the state’s taxpayers or the state guaranty fund.  And, who backstops the guaranty funds?  The same insurers.

The ultimate irony for those who have criticized an extension of TRIA because it puts the government at risk is that without TRIA, the government is at even greater risk, as all losses would end up being socialized.

MCM – What about large, self-insured employers?

Extending TRIA also is beneficial to employers self-insuring, because they will be able to secure sufficient excess coverage to remain self-insured.  After 9-11, we saw some migration from the self-insurance market to the insured residual market because self-insured employers were unable to secure adequate excess coverage.  These included here is Washington, high-profile risks such as the Washington Post and the Kennedy Center for the Performing Arts.

What does this mean for you?

Six years of certainty – at least about this exposure.


Jan
13

Failing health plans are inevitable. And that’s fine.

New health plans will go out of business.  Long-time players will find themselves losing share and priced out of markets. Some Co-ops will be too aggressive and underprice coverage, and those that push it too far will be gone.

Others will focus on narrow networks, use their financial wherewithal to build systems and staff expertise, manage medical aggressively and carefully, build strong relationships with selected providers and deliver service that delights their members.

“Our whole strategy has been to invest heavily in medical management because at the end of the day, we can’t make money the way we used to, which is to conservatively underwrite this population…. Financial people [at large carriers often] don’t understand the difference that real care management can make. Conservative underwriting is how carriers have made big profits in the past.”[emphasis added] That’s a quote (subscription required) from the CEO of a New Mexico Co-op health plan, and I could not agree more.

The health insurance business is no longer one where success is driven by risk selection; it is now driven by medical management.  Yet many legacy health plans have yet to fully embrace the new market dynamic, relying far too much on benefit design, variations of old-school underwriting and risk selection.  Sure, they THINK they’re adapting and changing, but they aren’t  moving fast or far enough.

Those who don’t understand what’s happening will blame “Obamacare”, not understanding that the Affordable Care Act is having precisely the effect it should; generating competition on a level playing field, rewarding innovation and aggressiveness, penalizing complacency and traditional approaches.

What does it mean for you?

It’s working.


Jan
12

It’s a delicious irony; academics at one of the nation’s top universities, averaging a cool $200k income, some of whom championed parts of health reform and PPACA, are whining about deductibles of $250, $20 copays for office visits, and out-of-pocket maximums of $1500 for individuals.

Oh, the tragedy!

Yes, part of the cost increase may be due to ACA requirements for dependent and preventive care coverage, the elimination of lifetime maximums, and a higher tax burden due to the Cadillac tax.

But these Cambridgians are merely experiencing higher insurance costs and more out-of-pocket costs – what the rest of us have dealt with for years.

What’s missing from the mass media’s reportage is any real understanding of two underlying concerns, concerns that are real, important, and significant.

First, requiring cost sharing does cause some reduction in necessary care.  There’s no question about that.  As reported in the NYT article; “Consumer cost-sharing is a blunt instrument,” Professor Rosenthal [of the Harvard School of Public Health] said. “It will save money, but we have strong evidence that when faced with high out-of-pocket costs, consumers make choices that do not appear to be in their best interests in terms of health.”

This is a valid concern, and one not getting near enough attention.  Deductibles and copays have far outlived their utility; they discourage seeking needed and unnecessary care.  And, once the member blows thru their out-of-pocket maximum, they don’t do anything to reduce unnecessary utilization.  As a relatively few people incur most health care costs, we need a far smarter approach than these crude cost dis-incentives.

Second, costs are high in large part because employees’ health care choices are very broad.  Again, the NYT: “Harvard employees want access to everything,” said Dr. Barbara J. McNeil, the head of the health care policy department at Harvard Medical School and a member of the benefits committee. “They don’t want to be restricted in what institutions they can get care from.”

And therein lies the rub.  Smaller, narrow expert networks deliver better outcomes for lower cost.

What does this mean for you?

I’d expect much better approaches will emerge soon.  Especially now that the real world has invaded the Halls of Academe.


Jan
9

Friday catch-up

The first week back from a couple of pretty slow weeks is always hectic – here’s a brief recap of what happened while we all were working.

The big news in the comp world is Congress passed the TRIA extension.  The President will certainly sign it, and we all can relax just a bit.  The six-year extension, which passed with overwhelming support in both Houses, includes a higher deductible and lower Federal cost-share in each of the next five years. The result will be more risk especially for smaller insurers who have less ability to cover potential claims from a major incident.

That said, the 9/11 attacks were just about the worst-case scenario, and the industry was able to absorb the financial hit without too much difficulty.

actually, that wasn’t the biggest news.

That was yet another announcement that the employment market is accelerating ; a quarter-million MORE jobs were added last month, lowering the unemployment rate to 5.6 percent. That bodes well for the insurance industry; the recent evidence that wages are improving is more good news.  Consumers’ energy costs down are dramatically, effectively increasing the average person’s annual wages by about $1000.

Expect consumer spending to increase; if moves to reduce the cost of housing bear fruit, that will help the construction and durable goods industries as well.

Here’s hoping our politicians don’t screw this up…

Thanks to Rob McCarthy for the heads-up on an op-ed piece by Ezekiel Emanuel recommending we skip that annual physical – they cost billions but there’s little evidence they have a positive impact on health or cost. Here’s the conundrum; from a societal perspective Dr Emanuel’s prescription makes sense, but as individuals we make decisions based on our own perceptions of risk and value...

A devastating piece about what it’s really like to be poor is making the viral rounds.  If you have ever blamed someone for being poor, having “too many kids” by “too many fathers”, for not using Medicaid or a free clinic, for smoking or not doing anything else you think they shouldn’t do, and not doing the things they should, read it. The whole thing. As one who is guilty far too often of these judgments, it was a virtual ice bucket in the face.